Uterine prolapse

Symptoms

Mild uterine prolapse is common after childbirth. It generally doesn't cause symptoms. Symptoms of moderate to severe uterine prolapse include:

• Seeing or feeling tissue bulge out of the vagina
• Feeling heaviness or pulling in the pelvis
• Feeling like the bladder doesn't empty all the way when you use the bathroom
• Problems with leaking urine, also called incontinence
• Trouble having a bowel movement and needing to press the vagina with your fingers to help have a bowel movement
• Feeling as if you're sitting on a small ball
• Feeling as if you have vaginal tissue rubbing on clothing
• Pressure or discomfort in the pelvis or low back
• Sexual concerns, such as feeling as though the vaginal tissue is loose

When to see a doctor

See a health care provider to talk about treatment options if symptoms of uterine prolapse bother you and keep you from doing daily activities.

Risk factors

Factors that can increase the risk of uterine prolapse include:

• Having one or more vaginal births
• Being older when you have your first baby
• Giving birth to a large baby
• Aging
• Obesity
• Prior pelvic surgery
• Chronic constipation or often straining during bowel movements
• Family history of weak connective tissue
• Being Hispanic or white
• Chronic coughing, such as from smoking

Prevention

To reduce the risk of uterine prolapse, try to:

• Prevent constipation. Drink plenty of fluids and eat high-fiber foods, such as fruits, vegetables, beans and whole-grains.
• Avoid heavy lifting. If you have to lift something heavy, do it correctly. Correct lifting uses the legs instead of the waist or back.
• Control coughing. Get treatment for a chronic cough or bronchitis. Don't smoke.
• Avoid weight gain. Talk with your doctor about your ideal weight and get advice on how to lose weight, if you need to.

Treatment

If you have uterine prolapse and it doesn't bother you, treatment may not be needed. You might choose to wait and see what happens. But when prolapse symptoms bother you, your provider may suggest:

• Self-care measures. Self-care measures might provide relief from symptoms or help prevent the prolapse from getting worse. Self-care measures include performing exercises to strengthen pelvic muscles. These are called Kegel exercises. You might also benefit from losing weight and treating constipation.
• A pessary. A vaginal pessary is a silicone device inserted into the vagina. It helps prop up bulging tissues. A pessary must be removed regularly for cleaning.

Surgery

Surgery may be needed to repair uterine prolapse. Minimally invasive surgery, called laparoscopic surgery, or vaginal surgery might be an option.

If you only have a uterine prolapse, surgery may involve:

• Taking out the uterus. This is called a hysterectomy. Hysterectomy may be recommended for uterine prolapse.
• A procedure that keeps the uterus in place. This is called a uterus-sparing procedure. These surgeries are for people who might want to have another pregnancy. There is less information on how effective these types of surgeries are. More study is needed.

But if you have prolapse of other pelvic organs along with uterine prolapse, surgery may be a bit more involved. Along with a hysterectomy to take out the uterus, your surgeon may also:

• Use stitches to fix weak pelvic floor structures. This can be done in a way that keeps the depth and width of the vagina intact for sexual function.
• Close the opening of the vagina. This procedure is called a colpocleisis. It may allow for an easier recovery from surgery. This surgery is only an option for those who no longer want to use the vaginal canal for sexual activity.
• Place a piece of mesh to support vaginal tissues. In this procedure, vaginal tissues are suspended from the tail bone using a synthetic mesh material.

All surgeries have risks. Risks of surgery for uterine prolapse include:

• Heavy bleeding
• Blood clots in the legs or lungs
• Infection
• A bad reaction to anesthesia
• Injury to other organs including the bladder, ureters or bowel
• Prolapse happens again
• Urinary incontinence

Talk with your health care provider about all your treatment options to be sure you understand the risks and benefits of each.

Preparing for an appointment

For uterine prolapse, you may see a doctor who specializes in conditions affecting the female reproductive system. This type of doctor is called a gynecologist. Or you may see a doctor who specializes in pelvic floor problems and reconstructive surgery. This type of doctor is called a urogynecologist.

Here's some information to help you get ready for your appointment.

What you can do

Make a list of:

• Your symptoms and when they began
• All medicine, vitamins and supplements you take, including the doses
• Key personal and medical information, including other conditions, recent life changes and stressors
• Questions to ask your health care provider

For uterine prolapse, some basic questions to ask include:

• What can I do at home to ease my symptoms?
• What are the chances that the prolapse will worsen if I don't do anything?
• What treatment approach do you recommend?
• How likely is it that uterine prolapse will happen again if I have surgery to treat it?
• What are the risks of surgery?

Don't hesitate to ask other questions you have.

What to expect from your doctor

Your provider is likely to ask you questions, including:

• Have your symptoms gotten worse?
• Do you have pelvic pain?
• Do you ever leak urine?
• Have you had a severe or ongoing cough?
• Do you do heavy lifting in your job or daily activities?
• Do you strain during bowel movements?
• Has anyone in your family had uterine prolapse or other pelvic problems?
• How many children have you given birth to? Were your deliveries vaginal?
• Do you plan to have children in the future?